Comparison of the efficacy of 3% hypertonic saline and 20% mannitol in reducing intracranial pressure in patients with traumatic brain injury

Anand Prakash; Vikas Kumar; Deepak Kumar; Manjar Ali; M. Habibullah Ansari

doi:10.18203/2320-6012.ijrms20242676

Authors

Anand Prakash Department of Neurosurgery, RIMS, Ranchi, Jharkhand, India
Vikas Kumar Department of Neurosurgery, RIMS, Ranchi, Jharkhand, India
Deepak Kumar Department of Neurosurgery, RIMS, Ranchi, Jharkhand, India
Manjar Ali Department of Neurosurgery, RIMS, Ranchi, Jharkhand, India
M. Habibullah Ansari Department of Neurosurgery, RIMS, Ranchi, Jharkhand, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20242676

Keywords:

TBI, Hypertonic saline, Mannitol, Intracranial pressure

Abstract

Background: Objective of the study was to compare the effects of 3% hypertonic saline (HTS) solution and 20% mannitol (MTL) solution on intracranial hypertension.

Methods: The prospective study subjects consisted of 60 patients with traumatic brain injury admitted to the Department of Neurosurgery, RIMS, Ranchi between March 2020 to February 2023. The subjects fulfilling the inclusion criteria were selected and divided into two groups: group A (n=30): treated with 3% HTS, and group B (n=30): treated with 20% MTL.

Results: All the findings were noted on Microsoft excel sheet and data were analyzed using the statistical package for the social sciences (SPSS) 21.0 package. Quantitative data were analyzed using student’s t-test (paired and unpaired) and categorical data were analyzed by the test of proportion, Chi-square, and Fisher’s exact test.

Conclusions: Both 3% HTS and MTL can effectively reduce intracranial pressure, but 3% HTS has a more sustained effect on intracranial pressure and can effectively increase cerebral perfusion pressure.

Metrics

Metrics Loading ...

References

Muzevic D, Splavski B. The lund concept for severe TBI. Cochrane Database Syst Rev. 2013;12:CD010193.

Shekhar C, Gupta LN, Premsagar IC, Sinha M, KishoreJ. An epidemiological study of TBI cases in a trauma centre of New Delhi (India). J Emerg Trauma Shock. 2015; 8(3):131-9.

Freeman WD. Management of ICP. Neurocritical Care. 2015;21(5):1299-323.

Upadhyay P, Tripathi V N, Singh R P, Sachan D. Role of HTS and MTL in the management of raised ICP in children: A randomized comparative study. J Pediatr Neurosci. 2010;5:18-21.

Diringer MN. The evolution of the clinical use of osmotic therapy in the treatment of cerebral edema. Acta Neurochir Suppl. 2016;121:3-6.

Boone MD, Oren-Grinberg A, Robinson TM. Mannitol or hypertonic saline in the seting of traumatic brain injury: what have we learned? Surg Neurol Int. 2015;6:177.

Weed LH, Mckibben PS. Experimental alteration of brain bulk. Am J Physiol. 1919;2.

Patil H, Gupta R. A comparative study of bolus dose of hypertonic saline, mannitol, and mannitol plus glycerol combination in patients with severe traumatic brain injury. World Neurosurg. 2019;125:e221-8.

Kochanek PM, Carney N, Adelson PD, Ashwal S, Bell MJ, Bratton S, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents-second edition. Pediatr Crit Care Med. 2012;13:S1-82.

Carney N, Totten AM, O’Reilly C, Ullman JS, Hawryluk GW, Bell MJ, et al. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 2017;80:6-15.

Cottenceau V, Masson F, Mahamid E, Petit L, Shik V, Sztark F, et al. Comparison of effects of equiosmolar doses of MTL and HTS on CBF and metabolism in TBI. J Neurotrauma. 2011;28:2003-12.

Kerwin AJ, Schinco MA, Tepas JJ 3rd, Renfro WH, Vitarbo EA, Muehlberger M. The use of 23.4% hypertonic saline for the management of elevated intracranial pressure in patients with severe traumatic brain injury: a pilot study. J Trauma. 2009;67(2):277-82.

Vialet R, Albanèse J, Thomachot L, Antonini F, Bourgouin A, Alliez B, et al. Isovolume hypertonic solutes (sodium chloride or MTL) in the treatment of refractory posttraumatic intracranial hypertension: 2 mL/kg 7.5% saline is more effective than 2 mL/kg 20% MTL. Crit Care Med. 2003;31:1683-7.

Sakellaridis N, Pavlou E, Karatzas S, Chroni D, Vlachos K, Chatzopoulos K, et al. Comparison of MTL and HTS in the treatment of severe brain injuries. J Neurosurg. 2011;114:545-8.

Mangat HS, Chiu YL, Gerber LM, Alimi M, Ghajar J, Härtl R. HTS reduces cumulative and daily ICP burdens after severe TBI. J Neurosurg. 2015;122:202-10.